Double-blind and placebo-controlled study of lithium for adolescent bipolar disorders with secondary substance dependency.
OBJECTIVE
To perform a double-blind, placebo-controlled, random assignment, parallel group, pharmacokinetically dosed study of lithium for adolescents with bipolar disorders (BP) and temporally secondary substance dependency disorders (SDD).


METHODS
Subjects were 16.3 +/- 1.2 years old and were comprehensively assessed during a 6-week outpatient protocol that included random weekly urine collection for drug assays and random and weekly serum collection for lithium levels.


RESULTS
Using both intent-to-treat (N = 25) and completer (n = 21) analyses, there were significant differences on continuous and categorical measures between the active and placebo groups for both psychopathology measures and weekly random urine drug assays. The mean scheduled weekly serum lithium level of active responders was 0.9 mEq/L. Addiction to both alcohol and marijuana was the most frequent category of SDD. Mean age at onset of BP was 9.6 +/- 3.9 years and of SDD was 15.3 +/- 1.3 years. There were multigenerational mood disorders in 96% and multigenerational SDD in 56% of families.


CONCLUSIONS
Lithium treatment of BP with secondary SDD in adolescents was an efficacious treatment for both disorders. These results warrant replication with a long-term maintenance phase. The mean 6-year interval between the onset of BP and onset of SDD strongly argues for earliest recognition of BP.
Geller
B
B
Washington University School of Medicine, St. Louis, MO 63110, USA.
Cooper
T B
TB
Sun
K
K
Zimerman
B
B
Frazier
J
J
Williams
M
M
Heath
J
J
D000293:Adolescent; D018692:Antimanic Agents / Q000097:blood / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000097:blood / Q000188:drug therapy*; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D017831:Diagnosis, Dual (Psychiatry); D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008094:Lithium / Q000097:blood / Q000627:therapeutic use*; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D019966:Substance-Related Disorders / Q000097:blood / Q000188:drug therapy*; D016896:Treatment Outcome
D018692:Antimanic Agents; D008094:Lithium